Objective: To investigate the safety and effectiveness of second-stage oblique supine percutaneous nephrolithoscopy combined with transurethral ureteral flexible lithotripsy in the management of complex renal stones. Methods: From March 2012 to March 2015, a total of 75 patients with complete or partial deerstalker kidney stones were included in this group, 14 patients had a history of open stone extraction surgery or percutaneous nephrolithotomy for stone extraction, including 41 males and 34 females, aged 22-72 years (mean 47.5 years). In the first stage, ultrasound localization puncture and single microchannel percutaneous nephrolithotomy were performed in the prone position, and in the second stage, holmium laser lithotripsy with percutaneous ureteral access combined with transurethral ureteroscopy was performed 5-7 days later, with general anesthesia in the oblique supine position combined with lithotripsy, and routine blood and urine tests were repeated on the first day after surgery to observe the infection. Results: All 75 patients completed the surgery successfully, and the abdominal plain film was reexamined 3 days after surgery. 2 cases had some stones remaining due to the narrow neck of the infrarenal calyx, and 1 case had a stone remaining in the diverticulum of the renal calyx. No surgical complications such as hemorrhage, blood transfusion and sepsis occurred during the perioperative period. Conclusion: Second-stage oblique supine percutaneous ureteral rigidoscopy combined with transurethral ureteral flexible lithotripsy for the management of complex upper urinary tract stones has the following advantages: the ureteral flexible scope can enter each renal calyx more easily, expanding the field of view of rigid nephroscopy, which can more easily deal with deerstalker stone branches and stones scattered in other renal calyces during lithotripsy, resulting in a higher rate of renal stone removal; the percutaneous nephroscopy’s percutaneous renal channel provides The percutaneous nephrostomy provides an outflow channel for the ureteroscope, which reduces the pressure in the renal pelvis during ureteroscopic lithotripsy, and at the same time makes it easier to remove the stones, improving the efficiency of lithotripsy and stone extraction. The second-stage oblique supine microchannel percutaneous ureteroscopy combined with transurethral ureteral flexible lithotripsy is safe and effective in the management of complex renal stones and is worthy of clinical promotion.